by Gregg Anthony Masters, MPH

“Primary care player Forward shutters after raising $400M, rolling out CarePods.”

The Mirage of Innovation

That headline didn’t surprise those of us who’ve spent decades in the ‘belly of the beast’ of American healthcare.

The startup Forward—touted as a revolutionary tech-leveraged primary care model—joins a long and growing list of high-profile, well-funded failures. The problem? These ventures often emerge from Silicon Valley optimism (some say naivete) , disconnected from the operational realities, workflows, culture and systemic dysfunction of U.S. healthcare.

Forward, despite its sleek CarePods and $400 million in investor capital, never tackled the root causes of failure in American primary care. Instead, like many of its predecessors—Myca’s Hello Health (Jay Parkinson, MD), Qliance (Erika Bliss, MD, CEO; co-founded by Garrison Bliss, MD—the “father of DPC”), and retail pharmacy-driven plays from Walgreens, CVS, and even Walmart—it offered a convenience-first, consumer-facing veneer without a sustainable financial core.

Qliance: A Case Study in Vision vs. Systemic Gravity

Qliance remains one of the most ambitious and instructive direct primary care (DPC) experiments of the past 25 years. The model was co-founded by Garrison Bliss, MD—widely known as the father of DPC—and later led by Erika Bliss, MD, who served as CEO during the company’s pivotal years. Qliance offered a flat-fee, subscription-based alternative to traditional insurance: patients paid a monthly membership for unrestricted access to primary care services.

Backed by high-profile investors, including Jeff Bezos and other tech leaders, Qliance promised to rewrite the rules of care delivery. But even with visionary leadership and strong capital support, it succumbed to the same systemic forces that have felled countless primary care models. Qliance shuttered in 2017, unable to scale its model within a fee-for-service dominant ecosystem and without integration into employer sponsored health insurance and optimally global capitation or shared-risk contracts.

The lesson? No matter how promising the care model, innovation that doesn’t restructure payment flows and risk alignment is doomed to struggle in a system designed to reward volume, not value.

The Cost Context: Why Primary Care Can’t Succeed in a Vacuum

According to the 2025 Milliman Medical Index, the annual healthcare cost for a typical American family now exceeds $35,000, nearly triple what it was two decades ago. This 188% increase in costs has vastly outpaced wage growth of just 84%, creating a chasm between affordability and care delivery.

Outpatient facility costs alone have surged 286%, while employers continue to shift more of the financial burden to families—now covering only 58% of costs compared to 60%+ in 2005.
Here’s the rub: without reorganizing delivery supported by essential infrastructure typically provided by management services organizations (MSOs) to assume global risk contracts, primary care remains the weakest link in a fee-for-service system. It gets underfunded, underpowered, and ultimately, underdelivered.

Reframing the Problem: Critical Care Is Just the Tip of the Spear

This isn’t just a primary care story—it’s a healthcare system failure story.

When critically ill patients are passed through a fragmented maze of siloed providers, without continuity, accountability, or real-time coordination, we get avoidable deaths, missed diagnoses, and catastrophic cost overruns. We get step-down units where no one owns the patient’s trajectory, and rapid response teams that don’t respond rapidly—as I personally witnessed in my son’s care.

Medical errors—both diagnostic and care management related—remain the third leading cause of death in the U.S., according to studies published in the BMJ and cited by the CDC. These aren’t rare events; they’re systemic features of a broken machine or in the words of Esther Dyson a ‘calcified hairball‘.

A New Model: Organizing Primary Care as the System Backbone

We know what works:

– Primary care physicians must embrace risk and control the local or regional delivery system architecture.

– Revenue must come from global capitation or percent-of-premium models, not piecemeal FFS.

– Primary care leaders should selectively contract with specialists and hospitals as the commodities they are—important, but not ecosystem managers.

– Centers of Excellence (COEs) can be selectively contracted for high-complexity procedures, but they shouldn’t run the care continuum.

Leonard Schaeffer, former HCFA (CMS predecessor) Administrator and the architect of WellPoint’s rise post for-profit conversion of Blue Cross of California, said it best:

“It’s time to pick your partners and start dancing.”

That was decades ago, and yet, we keep reinventing the wheel with every Forward, CityMD, or VillageMD that ignores the choreography and ‘plumbing’ (both culture and infrastructure) of value-based care. Editors note: The jury is still out on Amazon’s OneMedical. We shall see!

Conclusion: From Bystanders to Upstanders

If we truly want to reclaim accountability in both primary care and critical care, we must address the financial scaffolding that shapes behavior, quality, and outcomes.

The tech doesn’t matter if the incentives are wrong, i.e., ‘it’s the business model stupid‘.
The access doesn’t matter if no one owns the patient’s story.
And the capital doesn’t matter if you’re still dancing to a fee-for-service beat.

As costs continue to soar, outcomes stagnate and we lose more of our loved ones to ‘rudderless’ team based care models, we are beyond the point of ‘me too‘ ad copy or other superficial risk averse solutions. It’s time to build from the ground up—with primary care as the architect, not the afterthought.

by